Climate Change Adaptation Activities and Needs in US State and Territorial Health Agencies.

OBJECTIVE: To characterize US State and Territorial Health Agencies' (S/THA) climate change adaptation activities and priorities to facilitate appropriate investments, skills development, and support that will strengthen health sector capacity in response to a changing climate. DESIGN: In 2021, we conducted an online survey of S/THA staff requesting information on current activities related to climate change and health, the state of climate and health programming, and anticipated needs and priorities for assistance. We analyzed survey results using descriptive statistics. SETTING: US State and Territorial Health Agencies. PARTICIPANTS: We received responses from 41 of 59 S/THAs (69.5%). MAIN OUTCOME MEASURES: Implementation of S/THA climate and health programs (CHPs); engagement in climate and health activities; maintenance of hazard early warning systems and action plans; employment of climate and health communications strategies; capability to assess risks and adaptation needs related to various climate-sensitive conditions; priorities and plans for climate change adaptation in relation to climate-sensitive health risks; climate change adaptation-related partnerships and collaborations; requests of the Association of State and Territorial Health Officials (ASTHO) for advancing climate change adaptation activities; and the impacts of the COVID-19 pandemic on climate change work. RESULTS: Nineteen S/THAs reported having CHPs, the majority of which are federally funded. On average, S/THAs without CHPs reported engagement in fewer climate and health activities and more early warning activities. The S/THAs reported the highest levels of concerns regarding non-vector-borne infectious disease (66%), vector-borne infectious diseases (61%), and extreme heat (61%) hazards. CONCLUSIONS: As S/THAs with CHPs report substantially greater climate and health capacity than those without, additional federal and state investments (eg, Building Resilience Against Climate Effects [BRACE]) are urgently needed to catalyze climate and health capacity.

Adapting by Their Bootstraps: State and Territorial Public Health Agencies Struggle to Meet the Mounting Challenge of Climate Change

PREPAREDNESS GAPS IN THE PUBLIC HEALTH SYSTEM Concomitantly, the health effects of climate change and the need for public health system engagement are increasingly apparent. The primary federal effort to build state and local climate and health capacity has been the Centers for Disease Control and Prevention (CDC) Climate-Ready States and Cities Initiative, which has funded a handful of jurisdictions to implement its Building Resilience Against Climate Effects framework.8 Through its preparedness mandate, the CDC established this framework to provide guidance for state, territorial, and local health agencies in developing and implementing climate change adaptation activities. A lack of sufficient and sustained investments has forced STHAs to master the art of doing more with less;we can only begin to imagine what these agencies could do to prepare for and respond to the health effects of climate change with investments proportional to the magnitude of the threat. CONCLUSION Climate change is stressing our public health system, which is already on the precipice, by exacerbating health disparities, damaging health care facilities and resources, and stretching personnel and capabilities to their limits.